Can stress cause cancer?

Research has shown that stress and other psychological factors can influence cancer outcomes.

Did you know?


Hans Selye, the father of stress research, defined stress as the body’s response to any demand, whether that be an actual external demand or an individual’s perception of demands, influenced by their coping abilities.1


Psychosocial stress is associated with a physiological stress response, characterised by increased secretion of stress hormones.2


Research suggests that long-term exposure to hormones like cortisol and the fight-or-flight hormones adrenaline and noradrenaline, which the body releases in response to stress, may promote tumour growth.3,4


Overactivation of the stress response may impair immune response5, while the release of stress hormones may impact DNA repair and tumour cell growth.6,7


Stress biomarkers can also trigger and maintain chronic inflammation2, which has been shown to play various roles in cancer promotion and progression.8


Stressed individuals are also more likely than stress-free individuals to smoke tobacco9, consume excessive amounts of alcohol10, and be obese11, all behaviours that are risk factors for cancer12,13 and are associated with chronic inflammation.14

The Facts:


Studies on the potential role of chronic psychological stress on cancer incidence have shown conflicting results, suggesting an indirect association between stress and cancer risk.15


Studies that showed an association between stress and cancer:

  • A 24-year study of 1,462 Swedish women (aged 38-60 years) analysed the relationship between stress and subsequent breast cancer. Women who reported experiencing stress in the five years leading up to the initial examination were twice as likely as women reporting no stress to have breast cancer at the final examination, regardless of reproductive and lifestyle factors. 16
  • A 15-year Finnish study of 10,808 women investigated the relationship between stressful life events and breast cancer risk. For each single increase in stressful life events, the risk of breast cancer was 7% higher. When only major life events were considered (e.g. divorce, separation, or death of a spouse, close relative or friend), the risk estimate rose to 35%.17
  • A Canadian study of 1,933 men (aged 75 years or less) who had been recently diagnosed with prostate cancer found that 58% of men reported at least one job over their lifetime as stressful. In men younger than 65 years, perceived workplace risk duration was associated with a 12% higher risk of prostate cancer.15 

Studies that showed no association between stress and cancer:

  • The Breakthrough Generations Study investigated breast cancer risk in over 113,000 women in the UK, aged 16 or older. Researchers found that frequency of stress was not significantly related to risk of breast cancer; neither was having had a negative life event or events in the five years leading up to the study.18
  • An 8-year American study of 37,562 female registered nurses found no association between job stress and breast cancer risk.19
  • A Scottish study of over 7,000 adults from a variety of workplaces found weak associations between medium to high levels of daily stress and risk of developing breast cancer in middle-aged women or subsequent development of prostate cancer in men.20
  • A meta-analysis of 12 European cohort studies involving 116,056 adults (aged 17-70 years) found that high job strain was not associated with overall risk of cancer or risk of colorectal, lung, breast or prostate cancers.21

What can we do about it?


There is some evidence that diet may provide some protection against the effects of stress.22 Studies looking at the Mediterranean style of eating show that a mostly plant-based diet improves resilience and reduces risk of anxiety and depression. Eating wholegrains, legumes, fruits, vegetables, nuts, seeds and healthy plant fats helps reduce risk of some mental health problems, including stress.


Since chronic stress has been linked with higher rates of tobacco use9 and alcohol10 consumption, both of which can increase your risk of cancer, finding healthier ways to manage stress can be beneficial.


Emotional and social support6 can help you better cope with psychological stress. Take time to cultivate your relationships with loved ones.


Try out relaxation techniques such as deep breathing, progressive muscle relaxation and prayer.


Exercise has been shown to effectively reduce stress levels and cancer risk.23


Healthy sleep is essential to better manage stress. Make it a priority. Aim for seven to eight hours per night.


Find professional support through counselling or psychotherapy.


Regardless of whether stress directly causes cancer, there’s no doubt that stress affects your overall health.

Summary:

While research has not proven a cause-and-effect relationship between stress and cancer, people under stress may adopt certain behaviours, such as smoking, overeating (leading to obesity) or drinking alcohol, which increases a person’s risk for cancer. Finding new ways to manage stress through relaxation, exercise, eating well, adequate sleep and emotional support can be beneficial to reduce stress and may lower the risk of cancer. 

References

1.        Selye H. The Stress of Life. New York: McGraw-Hill; 1956.

2.        Hänsel A, Hong S, Cámara RJA, von Känel R. Inflammation as a psychophysiological biomarker in chronic psychosocial stress. Neurosci Biobehav Rev. 2010;35(1):115-121. doi:10.1016/j.neubiorev.2009.12.012

3.        Ross K. Mapping pathways from stress to cancer progression. J Natl Cancer Inst. 2008 July 2;100(13):914-917. doi:10.1093/jnci/djn229

4.        McEwen BS, Gray JD, Nasca C. Redefining neuroendocrinology: Stress, sex and cognitive and emotional regulation. J Endocrinol. 2015 Aug;226(2):T67-T83. doi:10.1530/JOE-15-0121

5.        Reiche EMV, Nunes SOV, Morimoto HK. Stress, depression, the immune system, and cancer. Lancet Oncol. 2004 Oct;5(10):617-625. doi:10.1016/S1470-2045(04)01597-9

6.        Lutgendorf SK, Sood AK, Anderson B, et al. Social support, psychological distress, and natural killer cell activity in ovarian cancer. J Clin Oncol. 2005 Oct 1;23(28):7105-7113. doi:10.1200/JCO.2005.10.015

7.        Antonova L, Aronson K, Mueller CR. Stress and breast cancer: from epidemiology to molecular biology. Breast Cancer Res. 2011 Apr 21;13(2):208. doi:10.1186/bcr2836

8.        Grivennikov SI, Greten FR, Karin M. Immunity, Inflammation, and Cancer. Cell. 2010 Mar 19;140(6):883-899. doi:10.1016/j.cell.2010.01.025

9.        Heikkilä K, Nyberg ST, Fransson EI, Alfredsson L, De Bacquer D, Bjorner JB et al. Job strain and tobacco smoking: An individual-participant data meta-analysis of 166 130 adults in 15 european studies. PLoS One. 2012 July 6;7(7):e35463. doi:10.1371/journal.pone.0035463

10.      Heikkilä K, Nyberg ST, Fransson EI, Alfredsson L, De Bacquer D, Bjorner JB et al. Job strain and alcohol intake: A collaborative meta-analysis of individual-participant data from 140 000 men and women. PLoS One. 2012;7(7):e40101. doi:10.1371/journal.pone.0040101

11.      Nyberg ST, Heikkilä K, Fransson EI, Alfredsson L, De Bacquer D, Bjorner JB et al. Job strain in relation to body mass index: Pooled analysis of 160000 adults from 13 cohort studies. J Intern Med. 2012 Jul;272(1):65-73. doi:10.1111/j.1365-2796.2011.02482.x

12.      Bagnardi V, Rota M, Botteri E, Tramacere I, Islami F, Fedirko V et al. Alcohol consumption and site-specific cancer risk: A comprehensive dose-response meta-analysis. Br J Cancer. 2015 Feb 3;112(3):580-593. doi:10.1038/bjc.2014.579

13.      Botteri E, Iodice S, Bagnardi V, Raimondi S, Lowenfels AB, Maisonneuve P. Smoking and colorectal cancer: A meta-analysis. JAMA - J Am Med Assoc. 2008 Dec 17;300(23):2765-2778. doi:10.1001/jama.2008.839

14.      Chida Y, Hamer M, Wardle J, Steptoe A. Do stress-related psychosocial factors contribute to cancer incidence and survival? Nat Clin Pract Oncol. 2008 May 20;5:466-475. doi:10.1038/ncponc1134

15.      Blanc-Lapierre A, Rousseau MC, Parent ME. Perceived workplace stress is associated with an increased risk of prostate cancer before age 65. Front Oncol. 2017 Nov 13;7:269. doi:10.3389/fonc.2017.00269

16.      Helgesson Ö, Cabrera C, Lapidus L, Bengtsson C, Lissner L. Self-reported stress levels predict subsequent breast cancer in a cohort of Swedish women. Eur J Cancer Prev. 2003;12(5):377-381. doi:10.1097/00008469-200310000-00006

17.      Lillberg K, Verkasalo PK, Kaprio J, Teppo L, Helenius H, Koskenvuo M. Stressful life events and risk of breast cancer in 10,808 women: A cohort study. Am J Epidemiol. 2003;157(5):415-423. doi:10.1093/aje/kwg002

18.      Schoemaker MJ, Jones ME, Wright LB, Griffin J, McFadden E, Ashworth A et al. Psychological stress, adverse life events and breast cancer incidence: A cohort investigation in 106,000 women in the United Kingdom. Breast Cancer Res. 2016;18:72. doi:10.1186/s13058-016-0733-1

19.      Schernhammer ES, Hankinson SE, Rosner B, Kroenke CH, Willett WC, Colditz GA et al. Job stress and breast cancer risk: The nurses’ health study. Am J Epidemiol. 2004 Dec 1;160(11):1079-1086. doi:10.1093/aje/kwh327

20.      Metcalfe C, Smith GD, Macleod J, Hart C. The role of self-reported stress in the development of breast cancer and prostate cancer: A prospective cohort study of employed males and females with 30 years of follow-up. Eur J Cancer. 2007 April;43(6):1060-1065. doi:10.1016/j.ejca.2007.01.027

21.      Heikkila K, Nyberg ST, Theorell T, et al. Work stress and risk of cancer: Meta-analysis of 5700 incident cancer events in 116 000 European men and women. BMJ. 2013;346:f165. doi:10.1136/bmj.f165

22.      Carvalho KMB, Ronca DB, Michels N, Huybrechts I, Cuenca-Garcia M, Marcos A, et al. Does the Mediterranean diet protect against stress-induced inflammatory activation in European adolescents? Nutrients. 2018 Nov;10(11):1770. doi: 10.3390/nu10111770

23.      Moore SC, Lee IM, Weiderpass E, Campbell PT, Sampson JN, Kitahara CM, et al. Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults. JAMA Intern Med. 2016 Jun 1;176(6):816–25. doi: 10.1001/jamainternmed.2016.1548

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Dr. Luiz Fernando SellaMD, MPH
Medical Doctor at the Federal University of Santa Catarina, Brazil, a Certified Lifestyle Medicine Physician and Health and Wellness Coach.